Pain, Hashimoto’s and Fibromyalgia…

Many of you have been asking me about how to relieve pain in a natural and root cause based approach. I’ve written up a new comprehensive post on strategies I’ve found to be the most helpful for my readers and clients in this week’s post.

Pain is a complicated and multifaceted issue, with many potential root causes, and therefore, many potential treatments. For example, a person may be in pain because of an injury, migraines, a structural abnormality, nerve damage, fibromyalgia, an autoimmune process, or because of an increased sensitivity to our environment…

Comprehensive Plan

Each pain disorder requires a unique, comprehensive treatment plan. The comprehensive approach to treating migraines is going to vary from the approach to treating a broken arm. 🙂

I can’t focus on every type of pain disorder with Hashimoto’s in this article, but I would like to provide some strategies that will help reduce pain in most pain disorders and specific resources for the most common types of pain disorders present in Hashimoto’s.

This article will focus on fibromyalgia, future posts in the works will cover carpal tunnel syndrome, migraines and I’ve already written about overcoming menstrual pain.

Conventional Approach to Pain

The most common conventional approach to pain is utilizing pain medications. Opiate medications and NSAIDs are the most common types of pain relievers used. Most medications have their time and place. As a pharmacist who is trained in both medication therapy management and functional medicine, I believe that instead of glorifying or demonizing medications, health professionals, and patients need to be educated about appropriate medication use AND complementary therapies that can eliminate or reduce the need for medications.

Opiates work by disconnecting our pain receptors from the pain signals, making us “forget” that we’re in pain. For many people, while these medications are effective “band-aids” for pain relief, they can also be habit-forming. The passing of the beloved artist Prince is a recent tragic example of what can happen when a person becomes addicted to opiate pain medications. Interestingly, Synthroid was the #1 prescribed drug in 2013 and 2014 in the United States. In 2015, Synthroid dropped to #2 and was displaced by Vicodin, an opiate painkiller.

Opiate medications are a constant source of controversy, on one hand, they are overused, and people become addicted to them and suffer ill consequences. Many times, these people had other choices for addressing their pain but were not informed.

On the other hand, people who are terminally ill, seriously hurt or injured, and others who may benefit from opiate medications often don’t get access due to the medical community’s fear of the medications.

NSAID medications (Non-Steroidal Anti-Inflammatory Drugs) are often a first line treatment for pain disorders, and they do help with reducing pain and inflammation. Unfortunately, they are also associated with numerous side effects, most significantly leading to gut dysfunction, including an increased likelihood of ulcers. For short-term use, the occasional headache or acute injuries, they can be very helpful- however, the longer we take them, the more likely we are to suffer adverse reactions.

We also know that pain medications don’t get to the root cause of the pain condition, and thus we need to take a comprehensive approach to reducing pain in the body.

Inflammation

No matter the cause, reducing inflammation in our bodies will always help reduce pain and promote healing. You don’t have to use NSAIDs to reduce inflammation!

Supplements for Pain

In May of 2015, I did a survey of my readers with Hashimoto’s, to identify some of the most helpful interventions specific to reducing pain.

While there is no “natural Vicodin”, up to 65% of my readers with Hashimoto’s reported a reduction in pain by taking Curcumin/Turmeric supplement. I’ve written about this anti-inflammatory spice in the past, and adding it to your daily regimen may help relieve your pain. (Be sure to get the extended release kind of Curcumin supplement that stays around in the body. The spice on its own gets cleared out too quickly to be an effective pain reliever).

The supplement Betaine with Pepsin also helped another 40% reduce pain. I wrote an entire post on this specific supplement a few months ago.

Other treatments that were not in my survey that I’ve found very helpful for helping with pain and inflammation with my clients include; Wobenzym, cannabis oil (sorry, don’t have links for you because it’s only legal in some states), magnesium, and Omega-3 Fatty Acids.

Additional interventions reported to be most helpful for pain by my readers include the following:

Nutrition Interventions

A whopping 62% of people reported that removing nightshade vegetables from the diet helped to reduce their pain. Nightshades include; tomatoes, potatoes, bell peppers, eggplants, tomatillos, Goji berries and the herb ashwagandha. As a side note, even if you’re not in pain, hot, capsaicin-containing peppers have the propensity to cause leaky gut, so they too could potentially contribute to autoimmunity. Side note number 2: black pepper, the seasoning is not a nightshade. Just has a similar name. 🙂 It may be hard to part with these foods, but for some, they can make a world of a difference. Try a nightshade free diet for 2 weeks to see if that makes a difference for you.

Low FODMAPs Diet-48% saw improvement in pain with the low FODMAPs diet, typically used for small intestinal bacterial overgrowth also helped people with pain.

Autoimmune Paleo Diet (which removes grains, nightshades, and eggs, but not FODMAPs) helped another 50% of people with pain. (Some of them didn’t have pain as an initial symptom, which is why the 50% may seem low).

To get started with the Autoimmune Paleo Diet, download my 2 Week Autoimmune Paleo Meal Plan below!

Additional diets that were reported to reduce pain include the Gluten-Free Diet (47%), the Grain-Free Diet (43%), as well as an egg-free diet (40%).

Healing Arts

Massage-62% of readers found that massage helped their pain (side bonus? 80% found it beneficial for mood as well). So if you’re in pain and struggling with depression, I urge you to treat yourself to a massage. Pharmacist’s prescription. 🙂

Acupuncture helped 61% of people with pain relief. I used to have a huge needle phobia- this is one reason why I went to pharmacy school and not medical school or nursing school! Part of me was afraid of the pain, another part of me afraid of contracting diseases with contaminated needles- but the needles used in acupuncture are teeny tiny and you can barely feel them. Furthermore, they are not reused so you don’t have to worry about getting germs from them.

I used acupuncture +chiropractic care + nutrition in the past to help recover from carpal tunnel.

Hidden Infections Can Cause Pain!

Treating the gut infection most commonly known for causing ulcers, Helicobacter Pylori helped reduce pain for 50% of people. I often see this infection in clients with chronic pain and migraines. This infection combined with NSAIDs is a double whammy risk for ulcers. A natural protocol I like to use is mastic gum and DGL for 60 days + cabbage juice (before you protest that cabbage is a goitrogen, please read this post on common Hashimoto’s food myths).

I also wanted to mention that my clients often test negative for H. Pylori on standard lab tests, but the stool antigen test utilized by functional medicine lab tests like the GI MAP, GI Effects, or Comprehensive Stool Analysis is more likely to uncover this infection.

Treating SIBO, or small intestinal bacterial overgrowth, helped 51% of people reduce their pain- Remember this point, I will be talking about my theory shortly… (I don’t have the time to outline SIBO treatments in greater detail in this post, but I’ve written about treatment protocols for SIBO in my book, and also do a deep dive in my Hashimoto’s Self-Management Program.)

Fibromyalgia & Hashimoto’s Connection

I want to spend a little time sharing some interesting connections I’ve pieced together over the last few years. Fibromyalgia, a type of chronic pain disorder, tends to go hand-in-hand with Hashimoto’s. Up to 33% of people with Hashimoto’s may have fibromyalgia, and autoimmune thyroid disease is thought to be a contributing factor to the development of fibromyalgia!

Sometimes people with Hashimoto’s are misdiagnosed with fibromyalgia, and sometimes people with fibromyalgia are told that their thyroid is responsible for their pain… but in fact, they may have fibromyalgia, and thus they don’t receive the proper treatment and suffer needlessly.

Either way, there is a lot of confusion about both conditions.

It angers me that a few years ago, fibromyalgia wasn’t even considered a “real disease” by many. Patients were told that it was just in their heads!

Part of the confusion, like with Hashimoto’s, is that many of the symptoms are nonspecific. In fact, many fibromyalgia symptoms overlap with Hashimoto’s. You may have fibromyalgia if you have the following symptoms:

• Tense and tight muscles, muscle spasms and chronic muscle pain
• Brain fog (also known as “fibro fog”) and depression
• Fatigue and lack of energy
• Insomnia/unrestful sleep
• Stiffness
• Numbness/tingling in extremities
• Multiple sensitivities (foods, cold, meds, smells, noise, bright lights)
• Pain after exercise
• Irritable everything! (anxiety, irritable bowel syndrome, irritable bladder)
• Migraines/tension headaches
• Jaw and facial tenderness
• Feeling like your hands/feet are swollen when they are not

While there are lab tests that can be done to diagnose Hashimoto’s, fibromyalgia diagnosis can be more complicated.

SIBO is an important root cause to consider when dealing with both Hashimoto’s and Fibromyalgia. One study found that 100% of people with fibromyalgia had SIBO, while another study found 50% of people with hypothyroidism had SIBO. My hypothesis is that the people with Hashimoto’s who responded that treating SIBO and the low FODMAPs diet reduced their pain also had fibromyalgia.

I believe that factors that can reduce stomach acid, like H. pylori, SIBO, and methylation issues that steal our trimethylglycine away seem to contribute to both fibromyalgia and Hashimoto’s…

In addition to the interventions I discussed above, additional things I’ve found to specifically help my clients with fibromyalgia include reducing overall inflammation, optimizing thyroid hormone levels, neurofeedback, Betaine with Pepsin and/or an MTHFR Pathways support supplement (which contains riboflavin, B6, methyl folate, B12, trimethylglycine, and L-serine).

I hope that this helps you on your journey to becoming pain-free! Remember- you can do it!

References

1. Symptoms of Fibromyalgia. WebMD. 2016. Available at: http://www.webmd.com/fibromyalgia/understanding-fibromyalgia-symptoms. Accessed June 17, 2016.
2. Bazzichi L, Rossi A, Zirafa C et al. Thyroid autoimmunity may represent a predisposition for the development of fibromyalgia?. Rheumatol Int. 2010;32(2):335-341. doi:10.1007/s00296-010-1620-1.
3. Shirzad N, Movassaghi S, Karmostaji H, Esfahanian F, Hemmatabadi M, Qorbani M. Association between fibromyalgia and thyroid autoimmunity. Endocrine Abstracts. 2015. doi:10.1530/endoabs.37.ep1004.
4. Suk J, Lee J, Kim J. Association between Thyroid Autoimmunity and Fibromyalgia. Exp Clin Endocrinol Diabetes. 2012;120(07):401-404. doi:10.1055/s-0032-1309008.